Clients and partners have asked for an official ODG response to the latest blog by Carlos Luna of Reed Group, attacking the research of WCRI and outcomes from ODG Formulary states including Texas.

Luna suggests that the massive cost-savings attributable to ODG guidelines and formulary adoptions may not equate to improvements in health outcomes. The position of ODG and our regulatory partners is the opposite. We believe the only way to achieve real and lasting cost-savings in workers’ comp is through the delivery of quality and timely care resulting in improved patient outcomes, and the best measure of success for workers’ comp reform efforts is time away from work.

When lost-time declines, the lives and livelihoods of workers injured on the job are changed for the better. Thankfully, in large part due to the hard work of the workers’ comp agencies and their stakeholders – TPAs, PBMs, MCOs, and providers charged with ODG implementation and concurrent reform measures – outcomes in ODG states have improved dramatically, including average lost time reductions of 34% (Texas) to 65% (Tennessee), cases receiving opioid doses of 90 MED or more down by 97% with total opioid usage down 58% (Texas), and claim cost declines resulting in annual premium reductions of 64% (Oklahoma), 63% (Texas), and 36% (Tennessee), among others.Luna tries to elicit fear in the marketplace, painting the ODG Formulary as “draconian” because it’s “binary,” advocating instead for a diagnosis-based formulary, but Luna confuses the role of treatment guidelines and formulary. A formulary adoption is a preauthorization rule, making it more difficult to prescribe the most dangerous drugs, but all medications, including both preferred and non-preferred drugs in the ODG Formulary, open complete evidence-based care guidelines in ODG, where diagnosis, duration, dose, and contraindications are discussed and outlined. It’s through the formulary-guideline linkage that patient selection criteria are applied in the clinician’s office and on the backend through UR.Luna either does not understand how successful formulary implementations work, or is intentionally misleading the industry. Either scenario is alarming, though given the track records of WCRI, ODG, and our regulatory partners, stakeholders can see through the obfuscation, and his agenda is obvious.In closing, thanks to WCRI for the excellent research, to stakeholders for your leadership implementing ODG, and to you, reader, for your interest in ODG and the opportunity to respond to criticism.Warmly,Phil LeFevreVP, Workers’ Comp, MCG Health,and Managing Director, ODGPhil.LeFevre@mcg.com​

there is one really big problem with the way the formulary was introduced and I believe currently managed in Texas, which is the apparent absence of any sustained follow up to see what happened to the patients no longer on opioids. I have spoken with Texas regulators about this. Perhaps in the past year they have begun tracking. A formulary without follow up seems to me risky.

Reply

ODG by MCG

3/5/2018 05:53:18 am

Peter - I also replied to you on LinkedIn. Your concern is an important one. The objective is to reduce dependencies on these dangerous drugs, not simply to switch payers, but thankfully the data is very encouraging that is happening. Although we don't know of a study that tracks specific patients over time, there are of course aggregate data return to work results which show improvement and, what may be even better, the state of Texas surveys injured workers who report greater satisfaction and access to doctors and specialists than before. This along with the greater number of doctors treating workers comp patients while claims are still decreasing means that at the very least there is no evidence that patients are merely leaving the W/C system. Still, it would be interesting if we could track patients who are weaned off opioids to see specifically how they are affected, and we look forward to such a study. Thank you, as always, for your insight.